OP0045 EULAR POINTS TO CONSIDER ON THE INITIATION OF TARGETED THERAPIES IN PATIENTS WITH INFLAMMATORY ARTHRITIDES AND A HISTORY OF CANCER
Authors: E. Sebbag, K. Lauper, J. Molina Collada, D. Aletaha, J. Askling, K. Benesova, H. Bertheussen, S. Bitoun, E. C. Bolek, G. R. Burmester, H. Canhão, K. Chatzidionysiou, J. Curtis, F. X. Danlos, V. Guimaraes, M. L. Hetland, F. Iannone, M. Kostine, T. W. Kragstrup, T. K. Kvien, A. Regierer, H. Schulze-Koops, L. Silva-Fernández, Z. Szekanecz, M. H. Buch, A. Finckh, J. E. Gottenberg
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Potential associations between targeted therapies and a new cancer in patients with an inflammatory arthritis (IA) and a history of malignant disease are a frequent concern in daily rheumatology practice. IA and/or immunomodulatory drugs might confer a specific risk of malignancy. No evidence-based framework has been proposed to guide clinicians on the benefit/risk balance when initiating or reinitiating a targeted therapy (bDMARDs/tsDMARDs) in this context. <h3>Objectives</h3> This initiative aimed to develop points to consider (PTC) to assist rheumatologists. when initiating/reinitiating a targeted therapy in the context of a previous malignancy. <h3>Methods</h3> Following EULAR standardised operating procedures, a task force of 2 patient representatives. and 25 experts (comprising 2 methodologists, 2 EMEUNET members, 1 oncologist. and 20 rheumatologists) first met to define the research questions for a systematic literature review concerning patients with IA and a history of cancer and other relevant information for consideration including: incidence of cancer in targeted therapy-treated patients and no history of cancer, translational research in onco-rheumatology, management with targeted therapy of immune-related adverse events of checkpoint inhibitors. In a second meeting, the task force formulated. the overarching principles and the PTC. <h3>Results</h3> The group formulated 5 overarching principles and 8 PTC relevant to the initiation of targeted therapies in patients with IA and a history of cancer. Major themes included a) the need to assess. the individualized risk of cancer recurrence based on the characteristics of the patient, the cancer and the underlying disease; b) the importance of engaging with specialists caring for the cancer and. to define treatment based on a shared decision between the patient and the rheumatologist; c) the possibility to initiate without delay an appropriate targeted therapy for the treatment of. the IA in patients in remission of their cancer; d) the proposal to prefer anti-cytokine bDMARDs. over other treatment options in patients with history of solid cancer and to prefer. B cell depleting therapy in patients with a history of lymphoma; e) the proposal to use JAK inhibitors and abatacept with caution, and only in the absence of therapeutic alternatives, based on. the significant increase in cancer incidence in patients without a history of cancer, with tofacitinib compared to anti-TNF in a randomized clinical trial, and a modest but significant increase. with abatacept compared to other bDMARDs in some observational studies. <h3>Conclusion</h3> The 2023 EULAR Points to Consider provide guidance on the management of targeted therapies. in patients with IA and a history of cancer. The research agenda highlights the need for studies. to evaluate targeted therapies other than TNF inhibitors and anti-CD20 to address the evidence gaps in this setting. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Eden Sebbag: None declared, Kim Lauper: None declared, Juan Molina Collada: None declared, Daniel Aletaha: None declared, Johan Askling: None declared, Karolina Benesova: None declared, Heidi Bertheussen: None declared, Samuel Bitoun: None declared, Ertugrul Cagri Bolek: None declared, Gerd Rüdiger Burmester: None declared, Helena Canhão: None declared, Katerina Chatzidionysiou: None declared, Jeffrey Curtis: None declared, François-Xavier Danlos: None declared, vera guimaraes: None declared, Merete Lund Hetland: None declared, Florenzo Iannone: None declared, Marie Kostine: None declared, Tue Wenzel Kragstrup: None declared, Tore K. Kvien Speakers bureau: Grünenthal, Sandoz, UCB, Consultant of: AbbVie, Amgen, Celltrion, Gilead, Novartis, Pfizer, Sandoz, UCB, Grant/research support from: AbbVie, Amgen, BMS, Galapagos, Novartis, Pfizer, UCB, Anne Regierer: None declared, Hendrik Schulze-Koops: None declared, Lucía Silva-Fernández Speakers bureau: Lilly, BMS, Abbvie, Novartis, Janssen., Consultant of: Novartis, MSD, Sanofi, Janssen, Pfizer, Zoltan Szekanecz: None declared, Maya H Buch: None declared, Axel Finckh Speakers bureau: AbbVie BMS, Pfizer Eli-Lilly Sandoz, Consultant of: AbbVie, Novartis, Pfizer, MSD, Lilly, Grant/research support from: AbbVie, BMS, Galapagos, Lilly, Pfizer, Jacques-Eric Gottenberg Consultant of: Abbvie, BMS, Galpagos, Gilead, Lily, Pfizer, Roche Chugai, Sanofi, UCB, Grant/research support from: Abbvie, BMS, Pfizer.